1. Weber Health Assessment in Nursing
Chapter 14: Assessing Skin, Hair, and Nails

2. Structure and Function of Skin
The skin is a physical barrier that protects the underlying tissues and structures from microorganisms, physical trauma, ultraviolet radiation, and dehydration.
Vital role in temperature maintenance, fluid and electrolyte balance, absorption, excretion, sensation, immunity, and vitamin D synthesis.

3. Skin, Hair and Nails
Skin- epidermis, dermis, subcutaneous layers
Hair- vellus, terminal
Nails- hard, transparent plates of keratinized epidermal cells

4. Question
Is the following statement True or False?
Sebum has some fungicidal and bactericidal effects.

5. Answer
True.
Sebum has some fungicidal and bactericidal effects.

6. Question
Is the following statement True or False?
Asians and Native Americans have strong body odor.

7. Answer
False.
Asians and Native Americans have mild to no body odor because of decreased sweat production. Caucasians and African Americans tend to have a strong body odor.

8. Skin Cancer
Most common of cancers
Three types: melanoma, basal cell carcinoma, squamous cell carcinoma
Asians are less susceptible

9. Risk Factors of Skin Cancer
Sun exposure
Nonsolar sources of ultraviolet radiation
Medical therapies
Family history and genetic susceptibility
Moles
Pigmentation irregularities
Fair skin that burns and freckles easily; light hair
Age

10. Risk Factors of Skin Cancer (Cont’d)
Male gender
Chemical exposure
Human papillomavirus
Xerodrem pigmentosum
Long-term skin inflammation or injury
Alcohol intake; smoking
Inadequate niacin in diet

11. Risk Reduction in Skin Cancer
Reduce skin exposure
Always use sunscreen when sun exposure is anticipated
Wear long-sleeve shirts and wide-brimmed hats
Avoid sunburns
Understand the link between sun exposure and skin cancer and the accumulating effects of sun exposure on developing cancers
Have annual skin cancer screenings

12. Risk Reduction in Skin Cancer
Ensure diet is adequate in vitamin B3
Examine the skin for suspected lesions
Use the ABCDE mnemonic to assess suspicious lesions:
Asymmetry
Border
Color
Diameter
Elevation

13. Question
Which skin disorder may be caused by exposure to the sun?
a. Acne
b. Cancer
c. Vitiligo
d. Warts

14. Answer
b. Cancer.
Rationale: Skin cancer may be caused by exposure to the sun. Acne, vitiligo, and warts are not caused by sun exposure.

15. Cultural Variations in Skin Cancer
Lowest rates: Asians
Highest rates: white Australians
Most susceptible are people with pale white, freckled skin and red hair

16. Risk Factors METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS
Assess for hospital-acquired MRSA risk factors:
Having an invasive medical device
Residing in a long-term care facility

17. Risk Factors METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (cont.)
Assess for community-acquired MRSA risk factors:
Participating in contact sports
Sharing personal items such as towels or razors
Suppression of the immune system function (e.g. HIV, cancer, or chemotherapy)
Residing in unsanitary or crowded living conditions (dormitories or military barracks)

18. Risk Factors METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (cont.)
Working in the health-care industry
Receiving antibiotics within the past 3 to 6 months
Young or advanced age
Men having sex with men

19. Measures to Reduce Risk Factors
Keep wounds covered.
Do not share personal items.
Avoid unsanitary or unsafe nail care practices.
If treatment has been started, do not stop until recovery is complete.
Use universal precautions when touching others to avoid contact with contaminated body fluids. Wash your hands.
Clean sports equipment between uses to avoid spread of infection.

20. Nursing History: Present Health Concern
Body odor problems
Skin problems (rashes, lesions, dryness, oiliness, drainage, bruising, swelling, pigmentation)
Changes in lesion appearance
Feeling changes (pain, pressure, itch, tingling)
Hair loss or changes
Nail changes

21. Nursing History (cont.)
Personal health history
Family history
Lifestyle and health practices
Exposure to sun or chemicals
Daily care of skin, hairs, nails
Usual diet and exercise patterns

22. Client Preparation
Ask the client to remove all clothing and jewelry
Have the client sit comfortably
Ensure privacy
Maintain comfortable room temperature

23. Equipment
Gloves
Examination light and penlight
Magnifying glass
Centimeter ruler
Wood’s light
Examination gown or drape

24. Skin Assessment: Inspection
Note any distinctive odor
Generalized color variations
Skin breakdown
Primary, secondary, or vascular lesions

25. Skin Assessment: Palpation
Lesions
Texture
Temperature and moisture
Thickness of skin
Mobility and turgor
Edema

26. Pressure Ulcer Risk Factors
Perception
Mobility
Moisture
Nutrition
Friction or shear against surfaces
Tissue tolerance decreased

27. Pressure Ulcer Risk Reduction
Inspect the skin at least daily and more often if at greater risk using risk assessment tool (such as Braden Scale or PUSH tool) and keep flow chart to document.
Bathe with mild soap or other agent; limit friction; use warm not hot water; set bath schedule that is individualized.
For dry skin: use moisturizers; avoid low humidity and cold air.
Avoid vigorous massage.

28. Pressure Ulcer Reduction (cont.)
Use careful positioning, turning, and transferring techniques to avoid shear and friction or prolonged pressure on any point.
Refer nutritional supplementation needs to primary care provider or dietitian, especially if protein deficient.
Refer incontinence condition to primary care provider.
Use incontinence skin cleansing methods as needed: frequency and methods of cleaning, avoiding dryness with protective barrier products.

29. Scalp and Hair
Inspection and palpation
General color and condition, cleanliness, dryness or oiliness, parasites, and lesions
Amount and distribution of scalp, body, axillae, and pubic hair

30. Nail Assessment
Nails
Inspection: Nail grooming and cleanliness, nail color and markings, shape of nails,
Palpation: Texture, assess texture and consistency, capillary refill

31. Nails Risk Factors
Nails in moist environment, especially walking in damp public locales or continuously wearing closed shoes; excessive perspiration.
Nail injury, trauma, or irritation
Immune system disorders such as diabetes mellitus and AIDS or on immunosuppressive medications.
Skin conditions such as psoriasis or lichen.
Some trades or professions
Contagion from one digit to another or one person to another.
Possibly family predisposition.

32. Nails Risk Reduction Tips
Wear leather shoes except for sports.
Avoid wearing closed shoes all the time.
Wear socks that wick away moisture.
Avoid going barefoot in damp public areas.
Avoid too much perspiration or water (wear gloves for hands).
Avoid trauma to nails.
Avoid unsanitary or unsafe nail care practices
If treatment is started, do not stop until recovery is complete.

33. Physical Assessment (cont.)
Capillary refill
Hair color and texture
Individuals of black American descent often have very dry scalps and dry, fragile hair.

34. Self-Assessment Skin, Hair, Nails
Refer to Box 14.1 Self Assessment: How to Examine Your Own Skin

35. Normal and Abnormal Findings
Share outcomes of assessment with peers

36. Pressure Ulcer Stages Stage One Stage Two Stage Three Stage Four
Unstagable

37. Primary Skin Lesions Macule and Patch Papule and Plaque
Nodule and Tumor
Vesicle and Bulla
Wheal
Pustule
Cyst

38. Secondary Skin Lesions
Erosion
Ulcer
Sacr
Fissure

39. Vascular Skin Lesions Petechia Ecchymosis Hematoma Cherry Angioma
Spider Angioma
Telangiectasis

40. Common Nail Disorders Longitudinal ridging Half and half nails Pitting
Koilonychia
Yellow nail syndrome
Paronychia

41. Common Changes Aging Skin Pale Skin lesions Dry Loses turgor
Hair: Thinner
Nails: Thickened, yellow, brittle

42. Validating and Documenting Findings
Health promotion diagnoses
Risk diagnoses
Actual diagnoses
Collaborative problems
Medical problems